Herbert Patrick, MD, BSEE, MSEE, FACP, FCCP, FCCM

Dr. Herbert Patrick is an Intensivist and Program Director of the Critical Care Medicine Fellowship Program at Jefferson Health. He completed his undergraduate bachelor and graduate master’s degrees in electrical engineering at the University of Pennsylvania. He worked in the biomedical industry until obtaining his medical degree at Jefferson Medical College and Pulmonary training at Temple University Hospital. He has been Pulmonary-Critical Care faculty at Jefferson University Hospital as Medical Director of Respiratory Care and at Hahnemann University Hospital as Director of Critical Care Services. He is triple board certified and a Fellow of the American College of Physicians, American College of Chest Physicians and American College of Critical Care Medicine.

Dr. Michael R. Pinsky is a Professor of Critical Care Medicine, Bioengineering, Cardiovascular Diseases, Clinical & Translational Science, and Anesthesiology at the University of Pittsburgh. His primary research interests are cardiovascular and pulmonary physiology, shock resuscitating, sepsis, energy metabolism, healthcare informatics, and outcomes research. He received his MD, CM from McGill University in 1974, Internal Medicine and Pulmonary fellowship at Stanford University in 1979 and Cardiopulmonary Physiology at Johns Hopkins Medical Institutions in 1981.

Maureen A. Seckel, RN, APRN, MSN, CCRN, CCNS, ACNS-BC, FCCM

Maureen Seckel has published and presented at national forums on critical care including evidence-based practices and sepsis. She is lead critical care clinical nurse specialist and sepsis leader for an 1100 bed healthcare system. She has expertise with both invasive and non-invasive monitors and methods to assess volume resuscitation. Maureen is an author on the 2016 Surviving Sepsis Guidelines and was a member of the Surviving Sepsis National Inpatient Collaborative.

Steven Q. Simpson, MD, FCCP, FACP

Dr. Steven Simpson has been the medical director for multiple tertiary and academic ICUs and has led the sepsis team at the University of Kansas since 2004. He is past chair of CHEST’s Critical Care NetWork, led CHEST’s annual postgraduate course in critical care for six years, and has served numerous times on the program committee for the CHEST annual meeting. He has extensive research experience in sepsis, including cell and molecular studies, clinical trials, translational studies, and epidemiology. He founded the Kansas Sepsis Project, a collaborative effort to raise the quality of sepsis care across his home state and has led the Midwest Critical Care Collaborative since its inception in 2005. Dr. Simpson is a member of the board of directors and is Medical Director of Sepsis Alliance, a national education and advocacy group for victims of sepsis.

Shock is a clinical manifestation of circulatory failure leading to inadequate tissue perfusion. Based on the pathophysiological mechanisms involved, four types of shock are recognized: hypovolemic shock (from fluid loss), cardiogenic shock (due to pump failure), obstructive shock (obstruction to blood circulation leading to inadequate oxygenation), or distributive shock (vasodilation resulting from the release of inflammatory mediators). Of these, distributive shock is the most common form of shock among patients in the intensive care unit (ICU). Distributive shock is often associated with sepsis but can also form an important component in other forms of advanced shock.

Early initiation of appropriate therapy – within an hour of development of hypotension – is crucial for clinical improvement and reduction in mortality. Education on the three-major blood pressure regulatory systems, as highlighted by the fact that although shock may be refractory to adrenal/sympathetic and arginine/vasopressin system-mediated therapies, these systems continue to be leveraged for managing hypotension, while the role of the RAAS may be underrecognized. Distributive shock can be refractory to treatment with catecholamine and fluid administration and patients may benefit from new and emerging therapies such as angiotensin II and agents acting on the RAAS.

This curriculum is designed to provide learners with a serial learning curriculum to bridge the knowledge and performance gaps related to distributive shock with personalized learner pathways. This educational initiative offers a two-phased curriculum. Phase 1 will offer a Self Assessment Program (SAP) to allow learners to assess their knowledge and skills in this area, compare their selections and scores with all other learners to date, and review commentary from the faculty. The goal of the SAP is to make learners aware of their strengths and weaknesses in this subject area.

After completing the SAP, learners will receive up to three brief, single-issue focused activities designed to cover all key learning points of the curriculum. Learners will be invited to participate in the subset of these activities that best address their learning gaps.

DISCLOSURE POLICY STATEMENT:

It is the policy of NACE to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. NACE assesses conflict of interest with its faculty, planners and managers of CME activities. Conflicts of interest that are identified are resolved by reviewing that presenter's content for fair balance and absence of bias, scientific objectivity of studies utilized in this activity, and patient care recommendations.

While NACE endeavors to review faculty content, it remains the obligation of each physician or other healthcare practitioner to determine the applicability or relevance of the information provided from this course in his or her own practice.

Kaitlyn Gregory, DNP, CRNP, FNP-BC, has no real or apparent conflicts of interest to report.

DISCLOSURE OF UNLABELED USE:

NACE requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.

DISCLAIMER

The opinions expressed during the educational activity are those of the faculty and do not necessarily represent the views of NACE. The information is presented for the purpose of advancing the attendees' professional development.

ACCREDITATION STATEMENT:

The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider Number 121222.

This CME activity was planned and produced in accordance with the ACCME Essentials and the AANP CE Standards and Policies and AANP Commercial Support Standards.

The National Association for Continuing Education designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim credit commensurate with the extent of their participation in the activity.

National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider Number 121222. This program has been approved for 0.25 hr contact hours of continuing education (which includes 0.25 hours of pharmacology)

TO OBTAIN CME CREDITS:

Read the learning objectives and faculty disclosures.

Participate in the activity.

Complete the post-test and activity evaluation.

Physicians who successfully complete the post-test and evaluation will receive CME credit.